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09.03.2015
This report was prepared by staff from the Department of Health and Human Services' Office of the Assistant Secretary for Planning and Evaluation in consultation with the Centers for Medicare and Medicaid Services, the Administration on Aging, the Department of Veterans Affairs, the Health Resource and Services Administration, and the Department of Labor's Bureau of Labor Statistics.
In fiscal year 2004, the Senate Labor, Health and Human Services, and Education Appropriations Bill requested that the Department of Health and Human Services (HHS) assess the availability of professional social workers in long-term care settings. This report is a product of work between the Office of the Assistant Secretary for Planning and Evaluation in HHS, other federal agencies in HHS, and the Departments of Labor and Veterans Affairs (VA). As noted earlier, the Senate Labor, HHS and Education Appropriations Bill requested that HHS assess the availability of professional social workers in long-term care settings. Bachelors of Social Work (BSW) programs prepare graduates for direct service positions such as case workers.
Masters degree programs in Social Work (MSW) prepare graduates for work in their chosen field of concentration, including health and aging, and continue to develop the skills required to perform clinical assessments, manage large caseloads, and explore new ways of drawing upon social services to meet the needs of clients.
Long-term care is generally defined as the array of medical, social, personal care and related services designed to meet the needs of people living with chronic health problems that limit their ability to perform everyday activities.
Social workers with a bachelor's degree in social work tend to be employed in long-term care settings at a higher rate than those with an MSW. Social worker responsibilities vary widely, depending upon the setting, and their role(s) in that setting. When bachelors and masters-level social workers are employed in the same long-term care setting, it has been reported that BSWs and MSWs typically have different, yet complementary responsibilities. The current BLS estimates and projections of social work employment do not include detail on level of education.
The CPS and the Census 1% PUMS data also do not identify social workers at the level of specificity corresponding to the Congressional request.
Estimates of the number of professional social workers from the 2002 BLS OEM, the 2004 CPS and the 2000 1% PUMS are presented in Figure 2.
Based on anticipated increases in demand for services and retirements of current practitioners, BLS predicts that total social work employment will increase from approximately 477,000 in 2002 to 604,000 by 2012.16 The industries that are expected to experience the largest increases in social worker employment are ambulatory health care services (health practitioner offices, outpatient care centers and home health care services), social assistance (individual and family services agencies, community services, vocational rehabilitation and child day care services), and nursing and residential care facilities (nursing care facilities, residential care facilities and community care facilities for the elderly). Assuming that the demand for professional social workers in long-term care is driven exclusively by growth in the older population and that all other factors influencing demand and supply of labor remain constant, the number of social workers can be projected for future years.
There are numerous factors--not necessarily unique to social work--that are likely to impact future demand and supply, therefore making it difficult to assess the adequacy of supply relative to demand. The job growth attributable to the aging of the population that will occur in long-term care settings will likely be shared between social workers and several other occupations.
While the future demand for services cannot be precisely predicted, it is likely that there will be an increased need for professional and paraprofessional workers, including social workers, to meet the growing demand in long-term care services.
An important factor influencing the supply of professional social workers in long-term care is the ability to attract students into social work careers in long-term care settings.
The number of social work students in the aging specialty also has significant implications for the future long-term care social work workforce. While the social work programs in the states mentioned above do provide some gerontological training, the majority of BSW and MSW educational programs contain little or no gerontology content. In preparing projections of future social work employment, we assumed that the current long-term care environment would remain constant. HHS held a series of informal discussions focusing on the supply and demand for professional social workers in long-term care settings. Stakeholders hypothesized that one hurdle to recruiting and training professional social workers--and other staff--into long-term care settings might be pervasive negative attitudes and stereotypes about aging and elders. The perceived lack of financial incentives in the form of stipends, loan forgiveness and wages is viewed as the most pronounced barrier to the recruitment and retention of professional social workers into long-term care careers.
Professional gerontological social workers in the not-for-profit and public sectors are increasingly being challenged to prove their value to their organizations. The projections of the number of professional social workers in long-term care were based on the assumption that the demand for, and supply of, social workers in the future would be driven exclusively by growth in the older population. Using data from the most recent OEM, the 2004 CPS, and the 1% PUMS from the 2000 Census, approximately 36,100 to 44,200 professional social workers are currently employed in long-term care settings.
If the ratio of professional social workers to the population age 65 and older remains constant, approximately 110,000 professional social workers will be needed in long-term care settings by 2050. While their theoretical framework may be unique, social workers in long-term care settings perform tasks, including assessment, psychosocial support, active treatment, and case management that may also be performed by other disciplines. There are efforts underway to include additional aging-related content into social work curriculum and to encourage professional social workers to seek employment in long-term care settings. Because of the uncertainties noted above, it is difficult to determine whether or not the current and future number of professional social workers will be adequate to care for an increasingly older American population; however, the likely increased demand for social work services will no doubt provide a strong impetus for continued job growth in the future. HHS has identified a set of tasks that could be undertaken in an effort to better understand and assess the future demand for and supply of professional social workers in long-term care settings.
Continue to encourage innovative state and local programs experimenting with new training curriculum for social workers in geriatrics and long-term care. Explore effective ways to ensure continuing educational opportunities for social work faculty specializing in long-term care.


Continue to support public and private initiatives currently underway intended to improve the availability of social workers with training in gerontology. Develop linkages between federal agencies and existing national strategic planning efforts and partnerships with professional associations, schools and other entities aimed at recruiting new pools of workers and providing training resources for social workers with geriatric training. In 1999, the Hartford Foundation launched a multi-year effort entitled "Strengthening Geriatric Social Work Initiative". The Atlantic Philanthropies have funded over $5 million in grants to provide continuing education as well as policy and health services research with the goal of increasing the supply and improving the quality of care provided to older adults by social workers. The Institute for Geriatric Social Work (IGSW), located at Boston University School of Social Work, is dedicated to advancing social work practice with older adults and their families. NASW and the Center for Health Workforce Studies at the University of Albany are analyzing the results of a national workforce study designed to obtain information about the education, job settings (including long-term care) and work activities of licensed social work professionals. The American Cancer Society funds a number of grants to support training, research and career development in areas of specific interest to oncology social workers working in both acute and long-term care settings. Under Title III-E of the Older Americans Act as reauthorized in 2000, the National Family Caregiver Support Program funded Care PRO, a collaboration between the American Society on Aging, the American Nurses Association, the American Occupational Therapy Association and NASW, to increase the skills and knowledge of professionals providing needed services to family caregivers. Indian Health Service (IHS) has a two-part scholarship program for health professionals, including clinical social workers, who must have a master's degree to practice. Another common term found in the literature is clinical social worker; these represent a subset of professional social workers that have obtained a master's degree and have completed at least two years of supervised therapeutic social work practice.
Specifically, the Bill directed HHS "to study and quantify the current and future supply and demand for professional social workers serving older adults across the continuum of long-term care services.
Staff at these Departments assisted this effort by sharing information and data on social workers in long-term care settings and reviewing sections of the Report to Congress.
This report presents our estimates of the current and future number of professional social workers in long-term care settings, using a definition of professional social worker from the National Association of Social Workers (NASW)4 and the Council on Social Work Education (CSWE).
Programs include courses in social work values and ethics, dealing with a culturally diverse clientele, at-risk populations, promotion of social and economic justice, human behavior and the social environment, social welfare policy and services, social work practice, social research methods, and field education.
Social workers seek to help people across the life span function better in their environments, identify and cope with problems and improve relationships with others.5, 7 Social workers may be distinguished from other "helping professionals," including nurses and psychologists, through their knowledge of community resources, their focus on client strengths (rather than pathology), skills in engaging the client and use of the person-in-environment (P-I-E) frameworkc for assessing and addressing psychosocial, psychological and social problems,9 and their pursuit of social change on behalf of vulnerable populations, such as long-term care residents. Barth's 2001 study of BSW and MSW employment markets indicates that these workers rarely compete with one another for jobs.11 For example, a social worker with a BSW in a nursing home might serve as a discharge planner for short-stay residents in a post-acute unit, while a social worker with a MSW might provide clinical supervision of the BSW as well as counseling and other behavioral interventions to long-stay residents and their families. The PRN collects data from social work practitioners, and uses the data to develop best practices, inform policy, and improve service delivery. However, in describing the education and training needed by most social workers to become fully qualified, BLS notes that, "While a bachelor's degree is the minimum requirement, a master's degree in social work or a related field has become the standard for many positions."12 For the purposes of this report, it was assumed that all BLS employment data on social workers refers to professional social workers. The growth in these industries will affect employment of social workers as well as other occupations, most notably nursing and social and human service assistants.16 As shown in Figure 4, the number of professional social workers employed in long-term care settings is projected by BLS in the Occupational Employment Matrix to increase from approximately 36,000 in 2002 to 55,000 in 2012. For example, the current proportion of professional social workers in long-term care settings per 1,000 persons age 65 and older in 2012 is 1.29 (55,189 divided by 42,863). Other professionals, such as registered nurses, and paraprofessionals (such as therapists, nurses aides, home health aides, personal care workers and other individuals calling themselves case workers or social workers) provide services and supports that may currently be considered under the purview of social work.12 For example, both registered nurses and social workers can perform hospital discharge planning functions, act as case managers and (with appropriate training and licensure, if required) provide psychotherapy.
Non-social work professionals and paraprofessionals may fulfill some portion of that demand.
Forty-one percent of respondents to the 1994 Council of Geriatric Education Centers' survey cited fiscal constraints as a major barrier to the recruitment of social work faculty with expertise in aging and to the development and offering of new courses. Practice-based research conducted by NASW showed that, in 1999, annual income among full-time social workers was lowest for those employed in nursing facilities and hospices.27 Specifically, these workers reported median income of $38,500 compared to $51,110 for full-time work in child welfare agencies and $43,330 in schools.
The topics of these discussions included: (1) overall perspective on social workers in long-term care settings, (2) factors affecting the supply of, and demand for, professional social workers in long-term care, and (3) cooperative strategies between HHS, schools of social work and professional associations that could address the adequate supply of professional social workers in long-term care. In addition, it is not clear how these tasks relate to specific credentials or demonstrated mastery in specific long-term care settings or working with specific sub-populations. Stakeholders further reported that the movement toward filling long-term care jobs with professional social workers is not consistently occurring because the demonstrated cost-effectiveness or efficacy of social work interventions in long-term care settings is not proven.
This is a strong assumption, and as discussed in Section IX, there are many factors--job substitution, changes in social worker training, changes in health care reimbursement policies that could in turn affect wages and benefits, and other changes in the long-term care infrastructure--that could influence future demand and supply.
It is unclear at this time whether or not these efforts will have a substantial impact on the future supply of professional social workers in long-term care. The Initiative consisted of several elements including a Faculty Scholars program of research support to junior faculty, a Practicum Partnership Program (PPP) demonstrating various educational training models, and the Social Work Competencies Project and Clearinghouse at CSWE (SAGE-SW, 2002).
It is part of a human capital development program targeted to enhancing the geriatric skills of doctors, nurses, social workers and direct care workers.
Established through a five-year grant from the Atlantic Philanthropies, IGSW is committed to improving the quality of gerontological social work practice and to helping practicing social workers effectively address the challenges of our diverse and growing aging population. The primary goal of the program was to train a minimum of 10,000 professionals from social work, occupational therapy and nursing professions in order to demonstrate increased competence in identifying the needs of family caregivers in their day-to-day practice.
Employers may also classify jobs as social work regardless of educational requirements; similarly, individuals may self-report their occupation as social worker, again without regard to educational achievement.
For a more complete description of social work theory and practice with older adults, please refer to A National Agenda for Geriatric Education: White Papers (Chapter 11, The State of the Art of Geriatric Social Work Education and Training) first published by the Health Resource and Services Administration (HRSA) in 1995.


In general, MSW-level social workers are specifically trained to provide counseling for complex problems, complete assessments, improve organizational functioning and perform other complex tasks that social workers with a BSW are not trained to do.
The sample is selected to represent the civilian non-institutionalized population age 16 and older, and respondents are asked detailed socioeconomic questions such as employment status, occupation, industry, earnings, hours of work, and other demographic variables such as education. The total number of professional social workers in long-term care settings can therefore be estimated by summing the number of social workers across long-term care industries. Focusing on professional social workers in long-term care settings yields a similarly narrow range of estimates--36,071 to 44,156 (Figure 3). Similarly, individuals holding a bachelor's degree in a human services field and social workers with a BSW deliver assessment and case management functions in many state and local departments of social services. However, the degree to which other professional workers and paraprofessionals substitute for a professional social worker in a long-term care setting is difficult to predict because it is related to a number of factors. BLS also indicated that the mean annual salary in 2002 for social worker positions in nursing care facilities ranged from $30,040 to $33,460, among the lowest of any setting.
Individuals with a bachelor's degree or higher may report that they are employed as a social worker, but may not have an actual BSW or MSW.
In 2001 it added a Geriatric Social Work Pre-Doctoral Fellows program and the Geriatric Social Work Curriculum Enrichment program that has since funded some 80 BSW and MSW programs with specific gerontological content across the U.S. IGSW offers a range of free or inexpensive, convenient, and accessible training programs to practicing BSW or MSW social workers--the large majority of whom have received little or no training in aging.
The survey captured information that will increase understanding of the clinical practice of social workers currently involved in the delivery of direct care services.
That year alone, 5,545 social workers received GEC grants; HRSA has funded grants to between 4,000 and 5,000 social workers under the GEC grant program in each of the subsequent years. The VA is affiliated with over 100 Graduate Schools of Social Work, and operates the largest and most comprehensive clinical training program for social work students--training approximately 600-700 students per year. Studies of the efficacy of social work services in aging with a focus on cost outcomes: Preliminary key points and information.
The Secretary of Veterans Affairs allows a newly hired social worker up to 3 years to become licensed at the independent level if they begin work without a license (VA can non-competitively direct hire social workers who complete a VA field placement within one year of graduation). As a result, the CPS can be used to identify respondents that report that their occupation is social work and who are employed in long-term care settings.
The surveys collect information on social workers' socioeconomic characteristics such as salary and education, clientele, and practice setting. The numbers likely vary due to differences in survey coverage, sampling variations, and differences in how a social worker is defined across the three data sources. These factors include regulatory requirements, the ability of employers to hire professional social workers, proven efficacy of social work interventions relative to other professionals or paraprofessionals in long-term care settings, and shifts in social service delivery systems and financing systems for long-term care. The PPP provided grants to six schools of social work to develop partnerships with consortia of field agencies.
The Geriatric Social Work Labor Force: Challenges and Opportunities in responding to an Aging Society.
Variables such as occupation, industry (setting), and education are available and can be used to determine if a respondent is a social worker in a long-term care setting. CSWE collects data annually on the numbers of individuals enrolled in accredited social work programs as well as the number of, and enrollment in, programs that offer an aging specialization (or aging-related field placements). The estimates may also understate the number of professional social workers serving the long-term care needs of the elderly because they work outside the industries identified in the surveys--home health agencies, nursing care facilities, residential care facilities, or community care for the elderly. Also in 2004, IGSW is beginning a large randomized controlled trial to test the effectiveness of a social work intervention in primary care, a project they believe will be the most important social work research project in the country. The IHS also offers a loan repayment program that is available to clinical social workers.
Moreover, the Veterans Health Administration (VHA) requires that all applicants for the position of social worker must have an MSW from a school of social work accredited by the CSWE and be licensed or certified at the master's level to independently practice social work in a state.e In addition, VHA has developed a core competency requirement for its long-term care social workers, including an annual aging-related competency assessment every year in which each social worker must present a psychosocial assessment and participate in peer review of cases. For example, social workers that do discharge planning for elderly patients in hospitals or other ambulatory care settings are not included in the tabulations. However, despite these data limitations, the estimates are remarkably consistent with NASW survey data on the number of professional social workers employed in nursing facilities, home health agencies, and hospices.
Four months post-graduation, over 80% of these graduates report working with older adults.30, 31 Over 24 million dollars have been expended from the John A. Hearst Foundation endowments of over $2,500,000 in geriatric social work education along with $30 million from other private sources have helped to reinforce this workforce development initiative. These private sector funds have shown that social work students do pursue careers in geriatric social work when incentives, training and educational supports are made available.



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